Objective: To explore effectiveness of arthroscopic Eden-Hybinette procedure with Triple-Pulley and four point anti-rotation fixation technique in the treatment of recurrent anterior dislocation of shoulder joint.
Methods: A clinical data of 14 patients with recurrent anterior dislocation of shoulder joint and glenoid bone defect, who were met the selective criteria and admitted between February 2021 and February 2022, was retrospectively analyzed. All patients were treated with arthroscopic Eden-Hybinette procedure and the bone blocks were fixed by using Triple-Pulley and four point anti-rotation fixation technique. There were 9 males and 5 females with an average age of 31.2 years (range, 22-40 years). Shoulder dislocation occurred 4-10 times (mean, 6.8 times). The time from the initial dislocation to the admission was 1-6 years (mean, 3.3 years). The Instability Severity Index Score (ISIS) was 7.2±0.8, the Beighton score was 2.9±2.4, and the width ratio of glenoid bone defect was 26.64%±1.86%. Pre- and post-operative visual analogue scale (VAS) score, the University of Califonia-Los Angeles (UCLA) shoulder score, Constant score, and American Association of Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder pain and function. The position, healing, resorption, and remodeling (glenoid area) of the bone blocks were evaluated by CT of shoulder joint.
Results: All patients underwent surgery successfully without any serious complications. All patients were followed up 11.5-13.8 months (mean, 12.0 months). The VAS scores of shoulder joint after operation decreased compared to preoperative levels, while the UCLA score, Constant score, and ASES score all increased, with significant differences ( P<0.05). And with the prolongation of time, the above indicators further improved, and the differences between different time points were significant ( P<0.05). Imaging reexamination showed that the bone block completely filled the glenoid defect, with good position and no significant displacement. Over time, the bone block healed and partially absorbed and remodelled. The postoperative glenoid area increased significantly compared to preoperative area ( P<0.05). With the prolongation of time, the glenoid area significantly decreased, but the difference was not significant between different time points ( P>0.05).
Conclusion: For the recurrent anterior dislocation of shoulder joint, Triple-Pulley and four point anti-rotation fixation technique in Eden-Hybinette procedure can effectively prevent bone rotation, make fixation more reliable, and easy to operate and achieve good effectiveness.
目的: 探讨关节镜下自体髂骨植骨三滑轮四点防旋固定术治疗复发性肩关节前脱位的疗效。.
方法: 回顾分析2021年2月—2022年2月符合选择标准的14例复发性肩关节前脱位伴关节盂骨缺损患者临床资料，均采用关节镜下髂骨植骨三滑轮四点防旋固定术治疗。其中，男9例，女5例；年龄22～40岁，平均31.2岁。肩关节脱位4～10次，平均6.8次。初次脱位至该次就诊时间为1～6年，平均3.3年。肩关节不稳严重程度评分（ISIS）为（7.2±0.8）分，Beighton评分为（2.9±2.4）分，关节盂骨缺损宽度比例为26.64%±1.86%。手术前后采用肩关节疼痛视觉模拟评分（VAS）、美国加州大学洛杉矶分校（UCLA）评分、Constant 评分以及美国肩肘外科医师协会（ASES）评分评价肩关节疼痛及功能；肩关节CT评估移植骨块位置、愈合以及吸收重塑（关节盂面积）情况。.
结果: 14例患者手术均顺利完成，无严重并发症发生。术后患者均获随访，随访时间11.5～13.8个月，平均12.0个月。患者术后肩关节 VAS评分均较术前降低， UCLA评分、Constant 评分及ASES评分均提高，差异有统计学意义（ P<0.05）；且术后随时间延长，上述指标均进一步改善，各时间点间差异均有统计学意义（ P<0.05）。影像学复查示，骨块完全填补关节盂缺损，位置良好且未发生明显移位，随时间延长骨块均愈合，并部分吸收、塑形。术后关节盂面积较术前明显增大，差异有统计学意义（ P<0.05）；随时间延长，关节盂面积逐渐减小，但术后各时间点间差异均无统计学意义（ P>0.05）。.
结论: 关节镜下自体髂骨植骨固定术治疗复发性肩关节前脱位时，采用三滑轮四点防旋固定，能够有效防止骨块旋转，固定更牢靠且操作简便，可取得良好疗效。.
Keywords: Eden-Hybinette procedure; Recurrent anterior dislocation of shoulder joint; Triple-Pulley; four point anti-rotation.